Provider Demographics
NPI:1649912882
Name:O'NEAL, DYLAN ERIC
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:ERIC
Last Name:O'NEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 HOLIDAY INN EXPRESS WAY NW STE 202
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-1469
Mailing Address - Country:US
Mailing Address - Phone:423-778-9671
Mailing Address - Fax:
Practice Address - Street 1:4312 HOLIDAY INN EXPRESS WAY NW STE 202
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-1469
Practice Address - Country:US
Practice Address - Phone:423-778-9671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN73714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine